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  Monday, 15 April 2019
  5 Replies
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Hi, my daughter is 13 and has crohns. In October 18 her Mesalazine was increased from 1g to 3g. By December 18 her creatinine levels had shot to 102 from 61 in Aug 18. Mesalazine was then stopped. In the last few months shes had a kidney scan and biopsy and been diagnosed with interstitial nephritis. Shes on a high dose of steroids and MMF to try reduce the inflammation. The levels are only slightly reduced so far. We arent sure if the damage caused is reversible. My question is do you know of other similar cases and was the damage reversible? And are there procedures of monintoring kidneys when increasing Mesalazine doses? TIA

I am sorry for your struggles with this.

I have seen interstitial nephritis in this context. Using immunosuppressive medications is controversial but I do use them in cases such as this. It can take months of treatment for the injury to fully "heal" if it is responsive to treatment. Doing repeat biopsy is the only way to really visualize the extent of healing or ongoing inflammation. As this is often impractical, we tend to monitor eGFR or creatinine changes alone. How long has your daughter been on the MMF/steroids?

Dr. Jordan Weinstein
5 years ago
Hi, thank you so much for replying. I am wondering if Mesalazine is a regular cause of damaged kidneys? If so if the dose was trebbled from 1g to 3g would it not be a requirement to check creatinine levels asap? Or is this a very rare case?

My daughter is now on a new drug called Vedolizumab for her Crohns. She was previoudly on Azathiorpine and Infliximab, then Methotrexate and Humira.

Since she was diagnosed with the intestinal nephritis she started taking 40mg Prednisone for a month and shes now being weened off so shes taking 40mg every day atm. The creatinine has dropped slightly but no where near back to her normal level. The highest it was was 111 and at the last test it was at the lowest at 84. She started on MMF a week ago and apparently shes going to stay on it between 6 & 12 months.

Do you have any other advice at all as we as parents are worried sick and if theres anything else you think we could do.

Shes already trying to drink more water and eat less unhealthy and salty snacks. Thank you
It is not a common reaction to this medication but it is described, and I have seen it personally. You would have to check with a GI doctor whether creatinine monitoring is standard of care. Bear in mind, nearly any drug can cause interstitial nephritis and therefore creatinine monitoring would be impractical.

In terms of your daughter's recovery, I would be very encouraged by the fall in creatinine she has experienced to date. Hopefully, as the inflammation subsides, she might experience even greater recovery of kidney function.

Dr. Jordan Weinstein
5 years ago
Thank you again for replying. I really appreciate it.

We are very encouraging about the fall in creatinine and every time she gets repeat bloods are just hoping for more improvement.

Do you think that once she comes off her steroids and eventually the MMF also that the inflammation will stay low? Because its caused by an injury rather than a disease? Unlike Crohns where its an ongoing struggle to keep inflammation levels down?

Thank you

It is definitely possible that she could recover from the injury now that the offending drug is removed and anti-inflammatory treatment has been used. Only time will tell whether some amount of reduced kidney function is present. That being said, the kidney fortunately has a large amount of reserve so that even if some permanent injury occurred, plenty of kidney function remains for a very good outcome moving forward.

Dr. Jordan Weinstein
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